Unwelcome Wake-Up Calls
Then there’s the bladder problem. Needing to go often or suddenly or simply having heightened bladder sensitivity (leading the body to think you have to go even when you don’t) can prevent you from getting the hours of uninterrupted REM sleep you need. One theory is that thinning tissues in the bladder and urethra lead to increased sensitivity. “Certain women don’t even fully wake up when they start getting those sensations—but just the heightened sensitivity and partial awareness are enough to negatively impact sleep,” says Hedaya.

A Controversial Solution
If biological changes are the root of your sleep problems, does taking prescription versions of sex hormones bring about restful nights? For many women, the answer is You bet!So far, hormone therapy (either a pill that combines estrogen and progesterone, or an estrogen-only pill, which is usually given only to women who have had their uteruses removed) is the single most effective treatment available for hot flashes and night sweats.

However, many women (and their doctors) were scared away from hormone therapy in 2002 when government researchers halted a major study out of concern that the protocol might raise the risk of breast cancer and heart disease. (For the most recent thinking on the safety of HT, go to more.com/ht​update.) Doctors have tried to minimize jeopardy in a few ways. One is to limit your exposure by prescribing the drugs on a short-term basis: You use hormone therapy to get through the years leadingup to menopause (which technically occurs on the day that’s one year after your last period) and possibly a year or two more. This is the regimen now recommended by most experts, says Hartford, Connecticut, ob-gyn Alicia Stanton, author of Hormone Harmony.

Another way to reduce risk is to take estrogen (alone, not in combination with progesterone) transdermally. Low doses of estrogen can be absorbed through the skin directly into the bloodstream via patches, a delivery method that’s less likely to precipitate blood clots and strokes, according to studies done in the last two years.

Typically, progesterone is taken with estrogen as part of HT to reduce the chances of developing uterine cancer. But lately cutting-edge research has begun focusing on using one particular form of progesterone in a new way, as a sleep aid. This formulation, called micronized oral progesterone (brand name: Prometrium), is derived from plants and is chemically identical to what your body makes. (The progesterone variant in most kinds of HT, progestin, is synthetic and differs importantly from your internal hormone.) According to a study reported at last year’s annual Endocrine Society meeting, women who took micronized progesterone pills slept more soundly and for a longer uninterrupted period than women who did not.

Prior, who has done much research on this pill, believes micronized oral progesterone is safer than most currently available sleeping pills, because unlike those medications, Prometrium is not addictive and does not decrease restorative REM sleep. To help patients sleep better, doctors may prescribe anywhere from 100 to 300 milligrams of Prometrium. Take the pill at bedtime every night for as long as you think you need it, Prior advises.

The problems associated with the combination of estrogen and progesterone have been well researched, but the use of progesterone on its own hasn’t been widely studied. Still, the evidence so far suggests that this hormone causes no serious side effects. Since any kind of treatment with sex hormones is controversial, consult an MD who is up on the latest research. One easy way to find a well-informed physician is to search on the website of the North American Menopause Society (menopause.org).

What You Can Take Besides Sex HormonesAmbien (zolpidem) and Lunesta (eszopiclone): These prescription sleep aids are relatively safe options as long as you don’t rely on them night after night, which could create a psychological dependency, says Santoro. In addition, most prescription sleeping pills, as well as over-the-counter ones (which are mainly antihistamines), make some people feel drowsy the next morning.